Becker's Hospital Review

58 CARE DELIVERY in hospital, home health, education and long-term care settings, she headed up Hillcrest's staffing overhaul and is now re- sponsible for the development and direc- tion of more than 140 employees. "Our goals were to lower agency us- age across the division and hire nurses in their place," Ms. Bible says. "So it seemed simple. We thought we would just de- termine where these agency nurses were working and then fill those spots. Well, it turned out that just to find out where they were staffed was a challenge." When the resource team began look- ing through the disparate facilities' sched- uling systems, they found some hospitals were using pen and paper, some were using computerized systems, and some had scheduling managed by a handful of people, all with different information that needed to be taken into account. "It was even difficult to figure out who to talk to at each respective facility," Ms. Bible says. "We had nurses with spe- cific qualifications who wanted certain shis in certain units on certain days, and we'd have to call and email their managers to navigate their individual schedules." Writing policies and procedures for a large teaching hospital in addition to a rural facility and a handful of others was an enormous workload that took a lot of time for a little return. If a facility had 10 nurses, Ms. Bible says, it may be a task that a CNO or administrator could do in a number of hours, but when dealing with over 100 nurses, it became clear that Hill- crest needed to expand to an automated system. Once ShiSelect was expanded across all of Hillcrest's facilities, adminis- trators and staff were able to make chang- es in scheduling by clicking through an electronic system, doing away with the need to make contact by phone or email to confirm shi coverage or availability. e automated system allows for details about particular staff members, such as experience, certifications or unit prefer- ences, which can be taken into account during scheduling. "Because the systems were so quick, the nurses were able to see things that administrators may have missed, too," Ms Bible says. "ey know what their respective skill sets are and whoever is making the schedule may not remember that a nurse is also qualified to work in a different area. e system has the ability to search for all of the shis staff mem- bers are qualified for, it also enables us to broadcast open shis, so nurses save time by logging on and making requests." But in addition to the autonomy the upgrade granted nurses and the other staffing messes it untangled, the system's adoption of API Healthcare's ShiSelect yielded other important results: Hillcrest attributes a savings of $2 million annually to streamlined staffing. "We attribute our savings to the fact that if we hadn't developed our resource team and had stayed on the same sort of trajectory we were on, we'd be spending more than we'd realize on overtime and agency costs," Ms. Bible says. Resolving staffing issues to improve a facility overall A smarter system's impact on staff morale can generate long-lasting change in a hospital or health system. Research shows that reducing the amount of over- time worked and minimizing lengthy back-to-back shis lowers turnover as job satisfaction increases. e same goes for patient outcomes — the less overworked members of a care team are, the lower the likelihood of medical errors. Additionally, the more a staff member feels their opin- ion matters, the more invested they are in the culture of a facility. "In the older, more industrial model of running a hospital, staff members were sort of seen as widgets, pegs to fill a hole," Dr. Kerfoot says. "e more people feel that way the less they interact, they don't make suggestions, they don't improve practices." One way to fix the widget problem is by moving toward a shared governance structure, the development of which Dr. Kerfoot says is directly linked to improv- ing staffing system-wide. A shared gov- ernance structure can take the form of a nursing committee or any staff-led orga- nization that takes into account the con- cerns of frontline healthcare workers. Aer forming its resource team, Hill- crest reached out to representatives from all of the parties affected by staffing deci- sions at its facilities to hear their respec- tive needs. e meeting of CNOs and unit managers enabled each group to share its feelings about the way staffing was han- dled and to ensure that the new system would account for everyone's interests. Ms. Bible says that this sort of relation- ship-building practice has noticeably lowered staff turnover and significantly boosted employee satisfaction response and support ratings to over 90 percent. Beyond the savings that add up from a reduced reliance on agency nurses, overtime and a high rate of shi cover- age — 83 percent at Hillcrest— using electronic systems equipped to think can produce a variety of useful metrics for hospitals, such as predicting shortages in specific units and providing focused feed- back that can be applied to hiring criteria. "Smarter staffing systems are an op- portunity to think beyond just the unit or beyond the hospital," Dr. Kerfoot says. "e way you become effective as a sys- tem is to connect your different facilities and units. Once you get the big picture of what's going on with staffing, then you can start to make changes that really do make a difference." n

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